Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

Herz, Naomi; Engeda, Joseph C.; Zusterzeel, Robbert; Sanders, William E.; O’Callaghan, Kathryn M.; Strauss, David G.; Jacobs, Samantha; Selzman, Kimberly A.; Piña, Ileana L.; Caños, Daniel

doi:10.1089/jwh.2014.4980

Cited by 27 publications

(15 citation statements)

References 124 publications

(149 reference statements)

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“…This resulted in near identical survival between groups based on factors traditionally thought to worsen outcomes in cardiovascular conditions. A similar phenomenon has been reported in a systematic review of cardiac resynchronization therapy trials—although women are markedly under‐represented in cardiac resynchronization therapy trials, when a cardiac resynchronization therapy device is implanted, women have a therapeutic response that is equivalent to or better than in men. Similarly, despite lower rates of ICD implantation in women in the USA compared with men, it has been shown that when access to treatment and counselling around ICD implantation is equal between the sexes, rates of ICD implantation are also equal …”

Section: Discussionsupporting

confidence: 74%

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

et al. 2019

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Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate-severe heart failure with reduced ejection fraction. Methods and resultsWe recruited 452 consecutive class II-III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence-based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow-up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74-1.92, 0.48). There was no difference in prescription of beta-blockers [χ 2 (1) = 0.91, 0.66], angiotensin-converting enzyme inhibitors [χ 2 (1) = 0.001, 0.97], nor aldosterone antagonists [χ 2 (1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter-defibrillator implantation in men compared with women [χ 2 (1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.

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Section: Discussionsupporting

confidence: 74%

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

et al. 2019

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“…The QRSd of 114 ms was a cutoff for predicting CRT responders, with an area under the curve (AUC) of 0.62 be shorter than those of Westerners and, by extension, we suspected that the indication for CRT in Japanese patients would be a shorter QRSd. Interestingly, several studies in which responses to CRT have been assessed in relation to the patients' sex have shown better responses to CRT among women than among men [15][16][17][18][19][20]. Our present investigation did not reveal a significant difference in the CRT response between the men and women.…”

Section: Discussioncontrasting

confidence: 54%

Narrower QRS may be enough to respond to cardiac resynchronization therapy in lightweight patients

et al. 2019

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A prolonged QRS duration (QRSd) is promising for a response to cardiac resynchronization therapy (CRT). The variation in human body sizes may affect the QRSd. We hypothesized that conduction disturbances may exist in Japanese even with a narrow (< 130 ms)-QRS complex; such patients could be CRT candidates. We investigated the relationships between QRSd and sex and body size in Japanese. We retrospectively analyzed the values of 338 patients without heart failure (HF) (controls) and 199 CRT patients: 12-lead electrocardiographically determined QRSd, left ventricular diastolic and systolic diameters (LVDd and LVDs), body surface area (BSA), body mass index (BMI), and LVEF. We investigated the relationships between the QRSd and BSA, BMI, and LVD. The men's and women's BSA values were 1.74 m 2 and 1.48 m 2 in the controls (p < 0.0001), and 1.70 m 2 and 1.41 m 2 in the CRT patients (p < 0.0001). The men's and women's QRSd values were 96.1 ms and 87.4 ms in the controls (p < 0.0001), and 147.8 ms and 143.9 ms in the CRT group (p = 0.4633). In the controls, all body size and LVD variables were positively associated with QRSd. The CRT response rate did not differ significantly among narrow-, mid-, and wide-QRS groups (83.6%, 91.3%, 92.4%). An analysis of the ROC curve provided a QRS cutoff value of 114 ms for CRT responder. The QRSd appears to depend somewhat on body size in patients without HF. The CRT response rate was better than reported values even in patients with a narrow QRSd (< 130 ms). When patients are considered for CRT, a QRSd > 130 ms may not be necessary, and the current JCS guidelines appear to be appropriate.

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“…This trend has been consistent over the past three decades [26]. .This disparity remained even after adjusting for the lower incidence of CHF in women.…”

Section: Gender Differences In Crt Utilizationsupporting

confidence: 60%

Cardiac Resynchronization Therapy in Women

Sharada¹

2016

Ind J Car Dis Wom

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ABSTRACT:Despite underrepresentation of women in cardiac resynchronization therapy studies, it has been conclusively shown that women demonstrate greater benefit than men in functional status, reverse cardiac remodeling, and survival and female gender remains an independent predictor of greater response to cardiac resynchronization therapy after adjustment for various other factors. Eligible female patients are less likely to receive this beneficial therapy and various performance enhancement initiatives can reduce this genderbased disparity with favorable outcomes.

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Sex Differences in Device Therapy for Heart Failure: Utilization, Outcomes, and Adverse Events

Abstract: Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.

Cited by 27 publications

References 124 publications

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

Narrower QRS may be enough to respond to cardiac resynchronization therapy in lightweight patients

Cardiac Resynchronization Therapy in Women

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